Advances in Chronic and Neuropathic Pain PDF
Preview Advances in Chronic and Neuropathic Pain
Contemporary Rheumatology Jeimylo de Castro Yasser El Miedany Editors Advances in Chronic and Neuropathic Pain Contemporary Rheumatology Series Editor Yasser El Miedany, Gravesend, UK Everyday rheumatologists are faced with new challenges pertaining to the management of both common as well as uncommon rheumatic disorders. The series, Contemporary Rheumatology, will explore new frontiers in rheumatology. It will cover both basic and clinical sciences and provide a state-of-the art approach to the diagnosis and management of different inflammatory as well as non- inflammatory conditions. This series will highlight emerging fields, treatments, and research in rheumatology from precision medicine to the use of cannabinoids in treatment of rheumatic diseases. By gathering key information on state-of-the-art care for practitioners of rheumatology, this series aims to support clinicians in developing new treatment plans for patients diagnosed with rheumatic diseases typically treated with more traditional approaches. In addition to demystifying newer technology and research in rheumatology, this series will also explore connections between rheumatic diseases and other disorders and medical specialties, such as osteoporosis in renal failure, the genetic factors to rheumatic diseases, and the bridge between rheumatic disease and sexual health. Patients with rheumatic conditions may be at increased risk for other chronic diseases, and it is crucial to those patients to have informed clinicians across specialties. These volumes will enable physicians outside the realm of rheumatology to better treat patients in their care who also suffer from rheumatic diseases. Research in rheumatology moves quickly, and there is continued focus on advancements in research and treatment. This series provides space in the rheumatology book program at Springer to track progress made in the field with series editor Dr. Yasser El Miedany, a leader in rheumatology, and continually provide state-of-the-art titles in the area. Jeimylo de Castro • Yasser El Miedany Editors Advances in Chronic and Neuropathic Pain Editors Jeimylo de Castro Yasser El Miedany SMARTMD Philippines Institute Medical Sciences Centuria Medical Makati Canterbury Christ Church University Makati City, Philippines Canterbury, Kent, UK ISSN 2662-7531 ISSN 2662-754X (electronic) Contemporary Rheumatology ISBN 978-3-031-10686-6 ISBN 978-3-031-10687-3 (eBook) https://doi.org/10.1007/978-3-031-10687-3 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword Pain is a condition that has confounded doctors and patients for millennia. Neuropathic pain, which reflects damage to the nerves themselves, has been particu- larly difficult to treat. As a practicing interventional pain, physician as well as a former pain fellowship director, I deal with the diagnosis and treatment of chronic and neuropathic pain every day. Dr. Jeimylo (Jim) de Castro and I have worked together for many years, through the World Institute of Pain (WIP), the Certified Interventional Pain Sonographer (CIPS) certification program, and the Philippine Academy of Rehabilitation conferences. He is a CIPS, a diplomate of the American Academy of Regenerative Medicine (DABRM, a diplomate of the Philippine Board of Rehabilitation Medicine, and chair of his rehabilitation department in Santa Rosa City, Philippines. Yasser El Miedany is a professor of rheumatology at Canterbury Christ Church University in the UK, and he is a fellow of both the American and British rheumatologic societies. Over the last few years, our understanding of the causes and treatments of vari- ous pain conditions, including neuropathic pain, has grown exponentially. Unfortunately, such information is scattered across multiple journals and textbooks. In this new book Advances in Chronic and Neuropathic Pain, Drs. de Castro and Miedany have gathered an international group of pain physicians to describe our current understandings regarding the pathophysiology, diagnosis, and treatment of chronic and neuropathic pain. In this book, you will find sections on the influence of age on pain (“Pain in chil- dren and young adults”; “Pain in older adults”) as well as current information on a variety of pain conditions such as cancer, degenerative disease, peripheral neuropa- thy, and phantom limb pain. There are sections on the pharmacologic, non- pharmacologic, and interventional treatment on pain. The editors have also included sections on diagnosis and outcome assessment. As the body of knowledge regarding pain grows, it is important for clinicians to have an available comprehensive reference, where the improvements in understand- ing are gathered in one location. This book is well designed for the young physi- cians studying for certification examinations, as well as for the established physicians v vi Foreword ready to update their understanding of the current state of chronic and neuropathic assessment and treatment. I congratulate the editors on this impressive book and I am honored to have been asked to write this foreword. Pain and Headache Center Andrea Trescot, MD, DABIPP, FIPP, CIPS Eagle River, AK, USA Preface Chronic and neuropathic pain is a complex spectrum of symptoms affecting the nerves of both children and adults. The International Association for the Study of Pain (IASP) defines it as pain caused by a lesion or disease of the somatosensory system. It may have a central or peripheral origin. Furthermore, pain that is longer than 3 months is considered chronic pain. Due to the ubiquitous and subjective nature of pain as a clinical manifestation, it is often difficult to identify the presence of neuropathic pain during the nascent phase of the disease. Therefore, clinical- based validated screening tools with an anatomical distribution of the extent of pain are used to determine the certainty of the disease. This is designed to help practitio- ners establish the existence of neuropathic pain and thus aid in the formulation of the treatment. Diagnostic testing protocols in the form of pain questionnaires, vali- dated screening tools, confirmatory tests for nerve damage, sensory testing, and neurophysiological techniques are available to help in the diagnosis and can com- plement the findings seen during clinical history taking and physical examination. Recently, composite pain biomarkers were identified to help us understand specific pain mechanisms which can guide clinicians in the diagnosis and management of this condition. The normal course of this condition varies from patient to patient. A French study, however, documented and followed the course of neuropathic pain and on average may take about 23 months from its onset to its diagnosis. However, an addi- tional 20 months are needed before a patient can be referred to a pain center. These centers may not be readily available in some countries such that primary physicians may refer these patients initially to pain specialists, neurologists, rheumatologists, oncologists, and even physiatrists with the hope that eventually appropriate man- agement may be provided to abate the symptoms of the patients. A single or a com- bination of drugs like calcium channel antagonists (Pregabalin and Gabapentin), tricyclic antidepressants, opiates, SNRIs, steroids, and NSAIDs medications are commonly used to address pain. More specific medications are given once the diag- nosis of neuropathic pain is established. While these medications provide immedi- ate relief, they have not been proven to deliver the needed lasting effects. Hence, considerations of more effective and advanced guided interventions by means of vii viii Preface fluoroscopy and ultrasound come into play. These modalities facilitate the delivery of medications to their target site more effectively. With these challenges in mind, we have worked along with world experts to tackle the problems of chronic and neuropathic pain, its diagnosis, clinical manifestations, and treatments. The role of both pharmacologic and non-pharmacologic therapies is initially given emphasis. More advanced approaches are introduced in this book for challenging patients with intractable pain using modalities to assess the sources and sites of pain. Ultrasound and fluoroscopy are effective modalities to guide interventional procedures among practitioners. We have also included regenerative therapies with their promising effects as a new intervention for chronic neuropathic pains. The book is structured by introducing a classification of chronic pain together with the challenges that every practitioner is dealing with. An in-depth discussion of the pathophysiology of chronic and neuropathic pains is included to provide readers with an appreciation of the disease process. The unique and peculiar clinical mani- festation of this disease among children and adults provides a distinct understanding of how this disease affects different age groups and thus, enables practitioners to achieve a different perspective in terms of assessment and treatment. Although neuropathic pain is a disease with a lesion in the somatosensory sys- tem, other diseases can mimic its presentation. Our authors, therefore, have included those diseases which have distinct peripheral nerve lesions as opposed to those with chronic clinical presentation of pain that may not have injuries involving the periph- eral nerves. These include cancer pain, degenerative diseases, complex regional pain syndromes, neuropathic pain syndromes, and fibromyalgias. With the con- stantly evolving understanding of this disease, modifications may inevitably change the approach to assessing the symptoms of this disease while trying to differentiate what is purely neuropathic versus those which are simply nociceptive in nature due to the absence of nerve injuries. The clinical assessment and diagnostic testing form a critical part of neuropathic pain management. In fact, the success of the treatment wholly or partially depends on the diligence one puts into this part of clinical evaluation. Outcome measures evaluate the patient prior to an intervention, the degree by which the patient responds to the treatment, and the risk categorization of the patient, thus providing us infor- mation on how effectively the treatment has impacted the course of the pain experi- enced by the patient. With all the research being done to understand chronic and neuropathic pain, treatment options are still evolving. For the last five years, we have seen new thera- pies coming into the scene and providing us with a helpful guide on how to control pain if unable to treat it effectively. However, we cannot entirely dismiss the contri- bution of existing medications and other non-pharmacologic treatments in regulat- ing neuropathic pain. Thus, our authors have meaningfully presented treatment options and protocols for the different stages of the disease and the level of severity of the disease with added precautionary measures when deleterious effects are observed during its prolonged administration. The use of image-guided interven- tional procedures such as fluoroscopy or ultrasound improves the outcome of pain relief as it targets specific lesions causing the pain. The portability and dynamic Preface ix feature of ultrasound makes it a preferred modality for most interventional procedures. Recently, regenerative therapies have positively been shown to be beneficial for pain attenuation by reducing the inflammatory state of the injured nerve and ulti- mately inducing tissue repair. However, more studies are needed to fully understand the therapeutic mechanisms for effective treatment. These advances have added value to the existing regimen of pain control mechanisms in addressing neuro- pathic pain. I hope that the advances written in this book take us closer to the hope stated in the “Good Book.” To wit, “neither shall there be any more pain; for the former things are passed away.” Revelation 21:4. I would like to thank my mentor and colleague, Dr. Yasser El Miedany for the opportunity to write this book with him and to all the chapter authors who have dili- gently contributed their time and skill to make this project possible. I also would like to thank my wife, Kyna de Castro, and my two kids, Rafael Bennett and Zarah Francine for the inspiration they have given me while preparing this book. And most of all, I thank our Almighty God for the discernment and wisdom for a project I could not possibly do without. Silang, Cavite, Philippines Jeimylo de Castro
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